Indirect decompression with lateral interbody fusion for severe degenerative lumbar spinal stenosis: minimum 1-year MRI follow-up

Takayoshi Shimizu MD, PhD, Shunsuke Fujibayashi MD, PhD, Bungo Otsuki MD, PhD, Koichi Murata MD, PhD and Shuichi Matsuda MD, PhD
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  • Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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OBJECTIVE

The use of indirect decompression surgery for severe canal stenosis remains controversial. The purpose of this study was to investigate the efficacy of lateral interbody fusion (LIF) without posterior decompression in degenerative lumbar spinal spondylosis with severe stenosis on preoperative MRI.

METHODS

This is a retrospective case series from a single academic institution. The authors included 42 patients (45 surgical levels) who were preoperatively diagnosed with severe degenerative lumbar stenosis on MRI based on the previously published Schizas classification. These patients underwent LIF with supplemental pedicle screw fixation without posterior decompression. Surgical levels were limited to L3–4 and/or L4–5. All patients satisfied the minimum 1-year MRI follow-up. The authors compared the cross-sectional area (CSA) of the thecal sac and the clinical outcome scores (Japanese Orthopaedic Association [JOA] score) preoperatively, immediately postoperatively, and at the 1-year follow-up. Fusion status and disc height were evaluated based on CT scans obtained at the 1-year follow-up.

RESULTS

The CSA improved over time, increasing from 54.5 ± 19.2 mm2 preoperatively to 84.7 ± 31.8 mm2 at 3 weeks postoperatively and to 132.6 ± 37.5 mm2 at the last follow-up (average 28.3 months) (p < 0.001). The JOA score significantly improved over time (preoperatively 16.1 ± 4.1, 3 months postoperatively 24.4 ± 4.0, and 1-year follow-up 25.7 ± 2.9; p < 0.001). The fusion rate at the 1-year follow-up was 88.8%, and disc heights were significantly restored (preoperative, 6.3 mm and postoperative, 9.6 mm; p < 0.001). Patients showing poor CSA expansion (< 200% expansion rate) at the last follow-up had a higher prevalence of pseudarthrosis than patients with significant CSA expansion (> 200% expansion rate) (25.0% vs 3.4%, p < 0.001). No major perioperative complications were observed.

CONCLUSIONS

LIF with indirect decompression for degenerative lumbar disease with severe canal stenosis provided successful clinical outcomes, including restoration of disc height and indirect expansion of the thecal sac. Severe canal stenosis diagnosed on preoperative MRI itself is not a contraindication for indirect decompression surgery.

ABBREVIATIONS CSA = cross-sectional area; DH-m = disc height at the middle of the vertebral body; DH-p = disc height at the posterior edge of the vertebral body; EBL = estimated blood loss; JOA = Japanese Orthopaedic Association; LIF = lateral interbody fusion; SDA = segmental disc angle.

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Contributor Notes

Correspondence Takayoshi Shimizu: Kyoto University Graduate School of Medicine, Kyoto, Japan. takayosh@kuhp.kyoto-u.ac.jp.

INCLUDE WHEN CITING Published online March 13, 2020; DOI: 10.3171/2020.1.SPINE191412.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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